Hospital EARC Certification - New Jersey...This supplemental training is not intended to replace the...

11/15/2019

Supplemental Training - Hospital EARC Certification 11-2019 1

S U P P L E M E N T A L T R A I N I N G

N O V E M B E R 1 4 , 2 0 1 9

Hospital EARC Certification

Welcome and Introductions

Theresa Edelstein

Vice President, Post-Acute Care Policy & Special Initiatives

New Jersey Hospital Association

Elizabeth Brennan

Director, Long Term Services and Supports

NJ Division of Aging

Deanna Freundlich

Lead Trainer, Office of Community Choice Options

NJ Division of Aging

2

11/15/2019


***IMPORTANT***

This supplemental training is not intended to replace the Hospital EARC Certification Training and Portal Overview as required for initial or recertification. For those requiring this certification training, please visit

https://www.state.nj.us/humanservices/doas/resources/ to access the certification training materials and recording link.

3

Training Objectives

Hospital EARC background and logistics

Target criteria

Cognitive and Activities of Daily Living (ADLs) items Define items, coding and considerations

Next Steps Deadline for Hospital EARC Certification

Competency Exam testing, required proficiency

Notification of Certification

EARC Portal Access and DoAS Service Desk support

4

https://www.state.nj.us/humanservices/doas/resources/

https://www.state.nj.us/humanservices/doas/resources/

11/15/2019


B A C K G R O U N D A N D L O G I S T I C S

Hospital EARC

Hospital EARC and Medicaid

Hospital Enhanced At-Risk Criteria Screening Tool

Utilized for individuals seeking NF transfer that meet identified target population with an expectation of billing Medicaid for all or part of their stay.

Completion and submission of the Hospital EARC by Hospital EARC Screeners with a valid certification.

If authorized, provides Medicaid reimbursement for up to 90 days, which is contingent upon full clinical and financial Medicaid eligibility.

6

11/15/2019


Authorized Hospital EARC Logistics

An authorized Hospital EARC is valid for one hospital admission. If readmitted to hospital and no valid PAS (full clinical eligibility for

Medicaid) on file, requires a new Hospital EARC be submitted.

Any EARC conducted prior to 2015 is valid as long as there has been no break in service from original admitting NF.

Once authorized, a Hospital EARC is valid for 10 days; allowing for nursing facility transfer with potential Medicaid reimbursement. If discharge to the NF does not occur within that timeframe, a new

Hospital EARC must be submitted for OCCO Review.

7

TARGET POPULATION

The Hospital EARC process is indicated for individuals:

1. Discharging from:

a. An acute, non-psychiatric hospital setting; or

b. A Long Term Acute Care Unit (LTAC);

2. Entering a Medicaid Certified Nursing Facility or Vent SCNF with an expectation of billing Medicaid for all or part of their stay:

a. Currently Medicaid eligible but not yet enrolled in NJ FamilyCare with a Managed Care Organization (MCO); or

NOTE: MCO enrollment cannot be initiated during hospitalization, deferred to 1st of month after D/C.

b. Potentially Medicaid eligible within 180 days.

8

11/15/2019


EXCLUSIONS: Requires Onsite OCCO Clinical Assessment

1. Individuals who are being referred for placement in a Special Care Nursing Facility (SCNF): AIDS, Behavioral, Huntington’s, Neurologically Impaired, Pediatric or TBI; Remember: Only Vent SCNF transfers are appropriate for Hospital

EARC. All other SCNFs require onsite OCCO clinical assessment.

2. Individuals who are in a Psychiatric Hospital or

Psychiatric Acute Care Unit.

NOTE: Requires submission of the completed LTC-4, Referral for Onsite OCCO Clinical Assessment form, available from the DoAS forms website at: https://www.state.nj.us/humanservices/doas/home/forms.html.

9

OTHER EXCLUSIONS: Not Eligible for Hospital EARC or Onsite OCCO Clinical Assessment

1. Individuals who are seeking Home and Community Based Waivers returning to the community;

2. Individuals who would not qualify for Medicaid within 6 months of NF placement who would be considered private pay;

3. Individuals who have a valid PAS on file (full clinical eligibility for Medicaid);

4. Individuals enrolled in NJ FamilyCare with a MCO upon entrance to hospital;

NOTE: If MCO enrolled, an authorization for NF placement must be obtained from the MCO.

(continued)

10

https://www.state.nj.us/humanservices/doas/home/forms.html

11/15/2019


OTHER EXCLUSIONS: Not Eligible For Hospital EARC or Onsite OCCO Clinical Assessment (CONT.)

5. Medicaid Fee-For-Service (FFS) individuals admitted from and returning to the same NF;

NOTE: Medicaid FFS represents individuals residing in a nursing facility enrolled in Medicaid prior to July 1, 2014. These individuals are not MCO enrolled.

6. Individuals whose PASRR Level II determination indicates “Requires Specialized Services”;

7. Individuals who are medically unstable, including those in the Emergency Room;

8. Individuals who are not in a NJ hospital.

11

Situations Outside of Eligibility Parameters

Outreach to the applicable Regional OCCO via telephone is recommended for situations outside the parameters of the identified target population or exclusion criteria.

Northern Regional Office of Community Choice Options (NRO OCCO):

COUNTIES: Bergen, Essex, Hudson, Hunterdon, Middlesex, Morris, Passaic, Somerset, Sussex, Union and Warren

PHONE: (732)777-4650

Southern Regional Office of Community Choice Options (SRO OCCO):

COUNTIES: Atlantic, Burlington, Camden, Cape May, Cumberland, Gloucester, Mercer, Monmouth, Ocean and Salem

PHONE: (609)704-6050

12

11/15/2019


C O N S I D E R A T I O N F O R P O T E N T I A L

C L I N I C A L E L I G I B I L I T Y F O R

E A R C A U T H O R I Z A T I O N

Cognition and Activities of Daily Living (ADLs)

COGNITION AND ADL SELF PERFORMANCE

Both cognition and ADL self-performance are considered for potential clinical eligibility for Hospital EARC authorization.

The Screener must fully investigate items within this section and code based on what is actually occurring to gain an understanding as to the individual’s cognition and

ADL self-performance over the last 3 days.

Interview of individual and/or legal representative;

Review of available documentation;

Communicate with applicable disciplines (physician, PT/OT/ST, nursing, aides, etc.)

14

11/15/2019


COGNITION

Overview: To determine the individual’s actual performance in

remembering, making decisions, and organizing daily self-care activities.

Areas of Cognition considered for Hospital EARC authorization:

DAILY DECISION MAKING

SHORT-TERM MEMORY

MAKING SELF UNDERSTOOD

15

Activities of Daily Living (ADLs)

OVERVIEW:

To determine what an individual is able to do for him/herself (self performance) and the support provided by others over the last 3 days

ADLs considered for Hospital EARC authorization:

BED MOBILITY

TRANSFER

LOCOMOTION

DRESSING (upper and/or lower)

EATING

TOILETING (toilet use and/or toilet transfer)

BATHING (consider for 7 days)

16

11/15/2019


D E F I N E I T E M S A N D C O D I N G ;

C O N S I D E R A T I O N S

Cognition

COGNITION: Daily Decision Making

DEFINITION: How patient makes decisions about organizing the day.

CONSIDERATIONS: Record individual’s actual performance in making everyday

decisions about tasks or ADLs.

Determine if mismatch between abilities and current level of performance.

EXAMPLES: Choosing items of clothing; Knowing when to eat meals; Using

environmental cues to organize and plan the day; Awareness of strengths and limitations; Making prudent decisions of how to respond to an emergency and/or the need to use assistive devices appropriately.

18

11/15/2019


COGNITION: Daily Decision Making

Requires full understanding of individual’s involvement with day-to-day activities/decisions. Interview and observe the individual, consult with caregiver or

direct care staff, review available medical records.

Questions asked during interaction will greatly assist Screener in understanding decision making ability.

19

CODING for Daily Decision Making

Independent

Modified Independence

Minimally Impaired

Moderately Impaired

Severely Impaired

No Discernable Consciousness, Coma

20

11/15/2019


Independent

with Daily Decision Making

DEFINITION:

Decisions consistent, reasonable, and safe.

CONSIDERATIONS:

There is no need for others to make decisions or provide cues/supervision as there are no safety concerns. Decision making ability fully intact.

21

Modified Independence with Daily Decision Making

DEFINITION:

Some difficulty in new situations only.

CONSIDERATIONS:

Patient may be challenged with decision making only when faced with new situations but is still capable of making sound decisions in most instances.

22

11/15/2019


Minimally Impaired with Daily Decision Making

DEFINITION:

In specific recurring situations, decisions become poor or unsafe; cues/supervision necessary at those times.

CONSIDERATIONS:

Due to cognitive issues, may have an increased incidence of making poor decisions, requiring cues/supervision only on occasion with different circumstances on occasion. May be independent with some areas of decision making but not all.

23

Moderately Impaired with Daily Decision Making

DEFINITION:

Decisions consistently poor or unsafe, cues/supervision required at all times.

CONSIDERATIONS:

Due to cognitive issues the decisions made by the patient at all times are not safe; therefore the patient requires cues/supervision to ensure safety.

24

11/15/2019


Severely Impaired with Daily Decision Making

DEFINITION:

Never or rarely makes decisions.

CONSIDERATIONS:

There is no occurrence of any decisions being made by the patient. Essentially all decisions are being made by another individual.

25

Cognition: Short Term Memory

DEFINITION:

Seems/Appears to recall after 5 minutes.

CONSIDERATIONS:

How is the individual responding through the assessment process?

Not remembering appointment; repeating self; answering questions inappropriately; or not remembering your name?

Conduct a structured test of short-term memory.

Ask the individual to remember three unrelated items and then have them repeat the items back after 5 minutes.

26

11/15/2019


CODING for Short-Term Memory

SHORT-TERM MEMORY: Can patient recall 3 items from memory after 5 minutes?

YES: Short-term Memory OK

Patient able to recall details as provided within a short window of time. Events of yesterday or failure to conduct a task outside of 5 minutes should not be considered as a memory problem.

NO: Short-term Memory problem Patient unable to recall details within 5 minutes. This may be realized by

asking patient to remember 3 items and then repeat within 5 minutes, or taking into account the patient’s repeated questions for information previously shared in a short time span but not recalled.

27

Cognition: Making Self Understood

DEFINITION:

How well does patient express or make self-understood (expressing information content, however able)?

Ability to express or communicate requests, needs, opinions, and urgent problems and to engage in social conversation

CONSIDERATIONS:

Can be via speech, writing, sign language, or a combination of these

Not meant to address differences in language understanding

Observation of interaction during interview necessary

28

11/15/2019


CODING for Making Self Understood

Understood

Usually Understood

Often Understood

Sometimes Understood

Rarely or Never Understood

29

Understood (Making Self Understood)

DEFINITION:

Expresses ideas clearly without difficulty.

CONSIDERATIONS:

Able to communicate without any question of what is being expressed. No need for others to prompt or anticipate needs.

30

11/15/2019


Usually Understood (Making Self Understood)

DEFINITION: Difficulty finding the right words or finishing

thoughts (resulting in delayed responses), BUT if given time, requires little or no prompting.

CONSIDERATIONS: May be challenged to a small degree to express self but

ultimately able to be understood with little or no prompting. If utilizing assistive device or speaking in another language they are usually understood.

31

Often Understood (Making Self Understood)

DEFINITION: Difficulty finding words or finishing thoughts,

prompting usually required.

CONSIDERATIONS: May be able to initiate communication but has difficulty fully

expressing thoughts without prompting.

If utilizing assistive device or speaking in another language they are understood after being prompted.

32

11/15/2019


Sometimes Understood (Making Self Understood)

DEFINITION: Limited ability, but is able to express concrete

requests regarding at least basic needs (food, drink, sleep, and toilet).

CONSIDERATIONS:

Patient only able to communicate basic needs, and/or utilizing noises or hand gestures to make self-understood.

If utilizing assistive device or speaking in another language they are sometimes understood.

33

Rarely or Never Understood (Making Self Understood)

DEFINITION: At best, understanding is limited to interpretation of

highly individual, person-specific sounds or body language.

CONSIDERATIONS: Patient not actively and/or effectively communicating. For

those instances where expression may have occurred, unable to comprehend what is being expressed.

Caregiver has learned to interpret person signaling the presence of pain or need to toilet.

34

11/15/2019


D E F I N E I T E M S A N D C O D I N G ;

C O N S I D E R A T I O N S

Activities of Daily Living (ADLs)

ADL: Bed Mobility

DEFINITION: How individual moves to and from lying position, turns side to

side, and positions body while in bed.

EXCLUDES transfers in/out of bed (considered in ADL – Transfer)

CONSIDERATIONS:

Includes alternative sleeping locations (e.g., lounge or geri chair, etc.)

Subtasks may include:

Lift self-up in bed; Reach/use trapeze; Raise/lower side rails; Managing bed controls; Move bed linens (sheet, cover); Prop pillows

Level of support required:

Self initiating, cues/reminders/oversight, placing necessary items within reach, physical support in any subtask for bed mobility?

36

11/15/2019


ADL: Transfer

DEFINITION: How individual moves to and between surfaces, including

to/from bed, chair, wheelchair, standing position.

EXCLUDES transfer to/from bath (considered in ADL – Bathing) or transfer to/from toilet (considered in ADL – Toileting)

CONSIDERATIONS:


Positioning of individual in preparation of transfer; ensuring the presence of necessary equipment, and locks brakes when assistive device used


Self initiating, cues/reminders/oversight, placing necessary assistive devices within reach, physical support in any subtask to transfer safely?

37

ADL: Locomotion

DEFINITION: How individual moves between locations on same floor

(walking or wheeling).

If in wheelchair, self sufficiency once in chair

CONSIDERATIONS:


Availability and use of assistive device if necessary; maintaining a steady gait/balance if walking


Self initiating, cues/reminders/oversight, placing assistive devices within reach, physical support in any way to assist with locomotion?

38

11/15/2019


ADL: Dressing

DEFINITION: Includes Upper and Lower Body Dressing

How individual dresses/undresses (street clothes, underwear), including prostheses, orthotics, fasteners, pullovers, etc.

EXCLUDES adjusting clothes before/during/after toileting (considered in ADL - Toileting)

CONSIDERATIONS:


Gathering appropriate articles of clothing, ability to dress/undress, and handle buttons/fasteners/zippers/prosthesis


Self initiating, cues/reminders/oversight, placing clothing items within reach, physical support in any subtask of dressing?

39

ADL: Eating

DEFINITION: How individual eats and drinks (regardless of skill)

Includes intake of nourishment by other means (e.g., tube feeding, total parenteral nutrition, IV fluids administered for nutrition or hydration).

CONSIDERATIONS:


Opening containers, cutting food, bringing food to mouth or other means of obtaining nutrition; monitoring for safety


Self initiated, cues/reminders/oversight with eating, need for assist with cutting food or opening containers, assist initiating task or any level of physical support with any subtask related to eating?

40

11/15/2019


ADL: TOILETING (toilet use and/or transfer)

DEFINITION:

How moves on and off toilet or commode

How uses toilet room (or commode, bedpan, urinal), cleanses self after toilet use or incontinent episode(s), changes bed pad, manages ostomy or catheter, adjusts clothes.

CONSIDERATIONS:


Gathering toileting items, adjusting clothing for toileting purposes, changing pad/under garments.


Self initiating, cues/reminders/oversight, placing toileting items within reach, physical support in any subtask for toilet transfer/use?

41

ADL: Bathing

DEFINITION: How individual takes full-body bath or shower. Includes how

transfers in and out of tub or shower AND how each part of body is bathed: arms, upper and lower legs, chest, abdomen, perineal area. (7 day look-back).

EXCLUDES washing of back and hair .

CONSIDERATIONS:

Bathing locations may include tub, shower, basin/sink, bed bath


Gathering items, safety getting into/out of bath (shower), physical process of washing and drying body, overall safety awareness.

Level of Support required:

Self initiating, cues/reminders/oversight, placing items within reach, physical support in any subtask of bathing?

42

11/15/2019


Coding for ADLs

Independent

Set-up Help Only

Supervision

Limited Assistance

Extensive Assistance

Maximal Assistance

Total Dependence

Activity Did Not Occur

43

ADL Coding: Independent

No help, setup, or oversight

NO LOOK, NO TALK, NO TOUCH

Individual is not instructed, cued or assisted with the task in any way.

Individual does all parts of the activity alone.

44

11/15/2019


ADL Coding: SET-UP Help ONLY

Article or device provided within reach of individual

NO LOOK, NO TALK, NO TOUCH

Examples: Cutting up meat

Providing grooming articles

Retrieving clothing

Providing wash basin and other bathing necessities

Providing incontinence supplies

Raising a bed rail

Handing a walker or other assistive device

45

ADL Coding: Supervision

Oversight, encouragement or cueing

LOOK and/or TALK, NO TOUCH

Oversight for safety considerations

Individual is prompted, provided instructions or cueing, but does not receive physical (hands on) assistance.

46

11/15/2019


ADL Coding: Limited Assistance

Individual is highly involved in activity; received physical help in guided maneuvering of limbs or other non-weight bearing assistance. TALK and TOUCH

Individual may be given instruction or cues but requires others to touch (physically assist); can be as simple as putting a hand on individual’s back or holding his/her elbow while walking.

Contact Guard or Hands-on Assist but NO weight-bearing support

Guided Maneuvering: physically directing individual in completing task without weight bearing assistance.

47

ADL Coding: Extensive Assistance

Weight-bearing support (including lifting limbs) by 1 helper where individual still performs 50% or more of subtasks.

TALK, TOUCH, and LIFT or SHIFT

1 helper provided weight-bearing support for all or part of the activity;

Individual highly involved in the activity (50% or more of sub-tasks).

48

11/15/2019


ADL Coding: Maximal Assistance

Weight-bearing support (including lifting limbs) by 2+ helpers; OR

Weight-bearing support for more than 50% of subtasks

TALK, TOUCH, and LIFT or SHIFT

Individual minimally involved in activity (others completing 50% or more of subtasks)

49

ADL Coding: Total Dependence

Full performance of the activity by another.

ALL ACTION BY OTHERS

Individual does not participate in any part of the activity being done for him/her (consider all subtasks)

If individual performed ANY part of the activity (was involved at any level), then total dependence cannot be coded.

50

11/15/2019


ADL Coding: Activity Did Not Occur

The ADL activity was not performed by the individual or others (regardless of ability) during entire period.

Keep in mind: When coding “Activity did not occur”, you lose consideration of that ADL for potential authorization.

51

ADL Self-Performance: CODING GUIDELINES

Assess the patient’s ADL Self Performance during the LAST 3 DAYS (except bathing, during last 7 days) considering all episodes of these activities (including sub-tasks).

If the person requires the same amount of assistance for an ADL on all 3 days, then code at that level;

Otherwise, determine the 3 most dependent episodes of assistance, then code using the least dependent of those 3 episodes.

52

11/15/2019


ADL CODING GUIDELINES: DECISION TREE

53

• D E A D L I N E F O R H O S P I T A L E A R C C E R T I F I C A T I O N

• C O M P E T E N C Y E X A M T E S T I N G A N D R E Q U I R E D P R O F I C I E N C Y

• E A R C P O R T A L A C C E S S A N D D O A S S E R V I C E D E S K S U P P O R T

Next Steps

54

11/15/2019


Next Steps

Deadline for Hospital EARC Certification has been extended to December 9.

For those requiring re-testing the Survey Monkey Hospital EARC Certification competency exam link will be forwarded tomorrow (Friday, November 15).

It is encouraged to have training materials available for reference at the point of testing.

55

Next Steps

Competency exam processing typically occurs within 5 to 10 business days after exam completion.

If a minimum score of 79% achieved, a notification of Hospital EARC Certification will be forwarded from [email protected]. Initial certification: Screener notified of new EARC Screener

Certification number.

Recertification: Screener instructed to utilize previously issued certification number.

If score is less than 79% re-testing is required. A link to an alternate version of the exam will be provided. Areas of deficiency will be identified.

56

mailto:[email protected]

11/15/2019


Next Steps

Participants who have met the required level of proficiency for EARC Certification will be provided EARC Portal Access. A request for EARC portal access will be forwarded to our Sales Force team

following notification of certification.

Expect an email from sender, Worker Portal within a couple of business days of EARC Certification notification

Portal access must be established within 24 hours (link expires)

If requires reset or other access or navigation concerns with the portal, outreach [email protected].

Include text “OCCO EARC” in subject line.

Identify as much detail as possible, including “snip-its” or screen shots as able.

Once portal access achieved, initiate electronic Hospital EARC Cease use of paper EARC

57

• T H A N K Y O U !

Questions and Answers

58




Hospital EARC Certification - New Jersey...This supplemental training is not intended to replace the...

Documents

Transcript of Hospital EARC Certification - New Jersey...This supplemental training is not intended to replace the...